Originally published as JCO Early Release 10.1200/JCO.2005.06.027 on January 4 2005

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Prognostic Index for Adult Patients With Acute Myeloid Leukemia in First Relapse

From the Dutch-Belgian Hemato-Oncology Cooperative Group (HOVON); Swiss Group for Clinical Cancer Research Collaborative Group (SAKK); Department of Hematology and HOVON Data Center, Rotterdam; Department of Hematology, Free University Medical Center Department of Hematology, Academic Medical Center, Amsterdam; Department of Hematology, University Medical Center, Utrecht; Department of Hematology, University Hospital, Groningen, the Netherlands; Department of Hematology, Hospital Gasthuisberg, Leuven, Belgium; and Department of Internal Medicine, University Hospital, Zürich, Switzerland

Address reprint requests to B. Löwenberg, MD, PhD, Erasmus University Medical Center, Department of Hematology, PO Box 2040, 3000 CA Rotterdam, the Netherlands; e-mail: b.lowenberg{at}erasmusmc.nl

PURPOSE: The treatment of acute myeloid leukemia (AML) in first relapse is associated with unsatisfactory rates of complete responses that usually are short lived. Therefore, a clinically useful prognostic index can facilitate therapeutic decision making and evaluation of investigational treatment strategies at relapse of AML.

PATIENTS AND METHODS: A prognostic score is presented based on the multivariate analysis of 667 AML patients in first relapse among 1,540 newly diagnosed non-M3 AML patients (age 15 to 60 years) entered onto three successive Dutch-Belgian Hemato-Oncology Cooperative Group and the Swiss Group for Clinical Cancer Research Collaborative Group trials.

RESULTS: Four clinically relevant parameters are included in this index (ie, length of relapse-free interval after first complete remission, cytogenetics at diagnosis, age at relapse, and whether previous stem-cell transplantation was performed). Using this stratification system, three risk groups were defined: a favorable prognostic group A (overall survival [OS] of 70% at 1 year and 46% at 5 years), an intermediate-risk group B (OS of 49% at 1 year and 18% at 5 years), and a poor-risk group C (OS of 16% at 1 year and 4% at 5 years).

CONCLUSION: The prognostic index estimates the outcome of AML patients in first relapse using four commonly applied clinical parameters and might identify patients who are candidates for salvage and investigational therapy.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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